Oliveira Samily Cordeiro De, Vasconcelos Antonio Helder Costa, Magalhães Emmanuel Pereira Benevides, Corrêa Fernanda Judith Vieira, Rodrigues Carlos Ewerton Maia
Medicine, Federal University of Ceará, Fortaleza, BRA.
Medicine, University of Fortaleza, Fortaleza, BRA.
Cureus. 2020 Sep 22;12(9):e10598. doi: 10.7759/cureus.10598.
Tumor necrosis factor-alpha (TNF-ɑ) inhibitors have become the mainstay of therapy for a wide range of autoinflammatory diseases, despite concerns regarding dermatological adverse reactions. In this paper, we describe the clinical and histological findings and outcome of a case of lichenoid eruption (LE) following adalimumab therapy for ankylosing spondylitis (AS) and review four earlier reports concerning this rare clinical association. The time of onset varied considerably (three weeks to 52 months) and lesions varied within the clinical spectrum (from typical lichen planus to psoriasiform), but all had LE-compatible histology, with acanthosis, necrotic keratinocytes and lymphocytic infiltrate as hallmarks. Most patients (3/5) improved with treatment and one experienced full recovery, while in one case the lesions persisted. TNF-ɑ has been implicated in the pathogenesis of lichen planus, making it difficult to explain how TNF-ɑ antagonists can induce lichenoid reactions. The appearance of LE may in some cases justify cessation of therapy.
尽管存在对皮肤不良反应的担忧，但肿瘤坏死因子-α（TNF-α）抑制剂已成为多种自身炎症性疾病治疗的主要手段。在本文中，我们描述了1例强直性脊柱炎（AS）患者接受阿达木单抗治疗后出现苔藓样疹（LE）的临床和组织学表现及转归，并回顾了4例关于这种罕见临床关联的早期报道。发病时间差异很大（3周~52个月），皮损在临床谱内也有所不同（从典型扁平苔藓到银屑病样），但所有病例组织学表现均符合LE，以棘层肥厚、坏死角质形成细胞和淋巴细胞浸润为特征。大多数患者（3/5）经治疗后病情改善，1例完全康复，而1例患者皮损持续存在。TNF-α与扁平苔藓的发病机制有关，这使得难以解释TNF-α拮抗剂如何能诱发苔藓样反应。在某些情况下，LE的出现可能说明有必要停药。
